脂肪乳预处理降低了下肢骨折手术中股神经和坐骨神经阻滞时左布比卡因的最大总血浆浓度和游离血浆浓度。

Lipid Emulsion Pretreatment Decreased the Maximum Total and Free Plasma Concentration of Levobupivacaine for Femoral and Sciatic Nerve Block in Below-Knee Fracture Surgery.

机构信息

Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China.

出版信息

Reg Anesth Pain Med. 2018 Nov;43(8):838-843. doi: 10.1097/AAP.0000000000000834.

DOI:10.1097/AAP.0000000000000834

PMID:29923955

Abstract

BACKGROUND AND OBJECTIVES

Although intravenous lipid emulsion has been proved a powerful antidote for local anesthetic toxicity, there are few pharmacokinetic data on using lipid infusion as a pretreatment for other clinical applications. We assessed the influence of lipid pretreatment on the pharmacodynamics and pharmacokinetics of levobupivacaine.

METHODS

Altogether, 12 patients undergoing below-knee surgery for a fracture were randomly assigned to 2 groups (6 patients per group): pretreatment with 1.5 mL/kg lipid infusion (lipid group) or saline infusion (control subjects) followed by complete femoral and sciatic nerve block with 0.375% levobupivacaine (2.5 mg/kg). Total and free (non-protein bound) plasma levobupivacaine concentrations and triglycerides in the lipid group were determined.

RESULTS

Results were given as means ± SD. Total and free maximum plasma levobupivacaine concentrations were lower in the lipid group than in control subjects (865 ± 98 vs 1145 ± 177 μg/L and 56.8 ± 7.5 vs 78.2 ± 13.7 μg/L, respectively; P < 0.01). Apparent volume of distribution and clearance were higher in the lipid group than in control subjects (211 ± 35 vs 170 ± 21 L and 35.1 ± 8.0 vs 25.8 ± 2.6 L/h, respectively; P < 0.05). Triglyceride level was significantly higher at the end of lipid infusion than baseline values (7.59 ± 1.32 vs 1.34 ± 0.39 mmol/L; P < 0.01).

CONCLUSIONS

Lipid pretreatment increased the apparent volume of distribution and clearance and decreased the maximum total and free levobupivacaine concentrations, thus offering a reasonable explanation for the effects of lipids on local anesthesia-related toxicity in humans. Rapid lipid infusion induced hypertriglyceridemia without other apparent risks in this study.

CLINICAL TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry, identifier ChiCTR-TRC-14005203.

摘要

背景与目的

虽然静脉内脂肪乳剂已被证实是一种强力的局部麻醉毒性解毒剂，但关于脂肪输注作为其他临床应用的预处理的药代动力学数据很少。我们评估了脂肪预处理对左旋布比卡因药效学和药代动力学的影响。

方法

总共 12 例因骨折行膝下手术的患者被随机分为 2 组（每组 6 例）：脂肪输注（脂质组）或生理盐水输注（对照组）预处理，然后用 0.375%左旋布比卡因（2.5 mg/kg）行股神经和坐骨神经完全阻滞。测定脂质组的总血浆和游离（非蛋白结合）左旋布比卡因浓度和甘油三酯浓度。

结果

结果表示为均数±标准差。脂质组的总血浆和游离最大左旋布比卡因浓度均低于对照组（865±98 比 1145±177μg/L 和 56.8±7.5 比 78.2±13.7μg/L；P＜0.01）。脂质组的表观分布容积和清除率均高于对照组（211±35 比 170±21 L 和 35.1±8.0 比 25.8±2.6 L/h；P＜0.05）。脂质输注结束时的甘油三酯水平明显高于基线值（7.59±1.32 比 1.34±0.39 mmol/L；P＜0.01）。